Provider Demographics
NPI:1033273925
Name:CROSS ROADS RESOLUTIONS, INC
Entity Type:Organization
Organization Name:CROSS ROADS RESOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-281-8903
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34143-0487
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:239-303-3100
Practice Address - Street 1:1120 HOMESTEAD RD N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6044
Practice Address - Country:US
Practice Address - Phone:239-281-8903
Practice Address - Fax:239-303-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0431951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ118COtherBLUECROSS BLUESHIELD
FLEL100ZMedicare PIN
FLZ118COtherBLUECROSS BLUESHIELD